6th ICHNO Abstract Book

6th ICHNO 6 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 16 – 18 March 2017 Barcelona, Spain __________________________________________________________________________________________ page 9

stage in non-OPSCC and p16- OPSCC patients, and it seems to be equivalent to the staging proposed by ICON-S in p16+ OPSCC patients.

to 150 comparisons (28,804 patients; 19,131 deaths and 20,586 PFS events). 16 treatment modalities were compared pairwise. Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment in all analyses. HR of HFCRT compared to platinum-based CRT was 0.80 [0.65-0.99] for OS (P-s 0.97) and 0.77 [0.62-0.96] for PFS (P-s 0.98). The table summarizes the comparison of the best treatments with platinum-based CRT and loco-regional treatment (LRT) alone for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P-score than platinum-based CRT (P-s 0.78) but their HR for OS were not significantly different: induction chemotherapy (TaxPF) followed by LRT (IC-LRT, (P-s 0.89)), accelerated radiotherapy with concomitant chemotherapy (ACRT, (P-s 0.82)) and induction chemotherapy (TaxPF) followed by CRT IC-CRT, (P-s 0.79)). Conclusion This update of the MACH-NC meta-analysis confirms the superiority of concomitant CT for locally advanced HNSCC with longer follow-up, when compared to induction treatment. The network meta-analysis suggests the superiority of HFCRT. Although toxicity is not addressed, these results, which ideally need to be confirmed by RCTs, could be clinically useful in advanced diseases with a high risk of locoregional failure (such as HPV negative disease), as represented by the patients in these meta-analyses. Additional analyses on other endpoints will be presented at the meeting.

Randomised trials: New data from randomised trials

SP-010 Update of the meta-analysis of chemotherapy in head and neck cancer (MACH-NC) P. Blanchard 1 , C. Landais 2 , B. Lacas 2 , C. Petit 1 , J. Bourhis 3 , J.P. Pignon 2 1 Institut Gustave Roussy, Radiation Oncology, Villejuif, France 2 Institut Gustave Roussy, Biostatistics and Epidemiology, Villejuif, France 3 CHU Vaudois, Radiation Oncology, Lausanne, Switzerland Introduction Our previous meta-analysis showed that concomitant chemotherapy (CT) improved overall survival (OS) in patients with non-metastatic head and neck squamous cell carcinoma (HNSCC). The study purpose was to update patient follow up, gather data on toxicity and include randomized trials conducted up to 2010, and to perform a network meta-analysis using data from MACH-NC and MARCH (meta-analysis on altered fractionation radiotherapy, updated data presented at ECCO 2013). Methods A fixed effect model was used for the standard meta- analysis. The log-rank test, stratified by trial, was used to compare treatments. OS was the primary endpoint. Progression free survival (PFS), locoregional control and distant control were the secondary endpoints. The network meta-analysis was performed under a frequentist approach using random effects due to significant heterogeneity. P-score (P-s), the percent of certainty to be the best treatment, was used to rank treatments. Results 15 new trials (2,574 patients) were included. Updated data were obtained for 11 additional trials. For the comparison of LRT vs. LRT + CT, 94 trials (18,394 patients) with median follow-up of 6.7 years were analyzed and 8 trials (1,214 patients) for the comparison of induction CT to concomitant CT. The addition of CT improved OS with a hazard ratio (HR) [95% confidence interval] of 0.89 [0.86; 0.92], p<0.0001. There was a significant interaction between treatment effect and the timing of CT, the benefit being limited to concomitant CT (p<0.0001), with a HR of 0.83 [0.79-0.87], translating into a 5-(10-)year absolute survival benefit of 6.5 (3.4)%. The addition of induction CT did not increase OS, with a HR of HR=0.97 [0.91-1.03]. Analyses performed in recent concomitant trials revealed a trend toward decreased efficacy with increasing age (p for trend=0.06; HR of 1.00 [0.81-1.23] for age≥70) or performance status (p for trend=0.07, HR of 0.93 [0.73-1.19] for PS≥2). The network includes data from 117 RCTs, corresponding

Tax-PF=

Taxane,

Platin

and

5-Fluorouracil.

Supported by INCa (PHRC, PAIR-VADS) and LNCC

SP-011 Update of the PET NECK trial H.Mehanna 1

1 University of Birmingham, Institute of Head and Neck Studies and Education, Birmingham, United Kingdom Abstract text The PET Neck trial examined the efficacy of a PET CT guided active surveillance policy compared to planned neck dissection for the management of advanced nodal disease in patients receiving radical chemoradiotherapy for advanced head and neck squamous cell carcinoma. It randomised 564 patients into PET CT guided active surveillance or planned neck dissection. The study found that there was no difference in overall survival or locoregional control between the two arms. There were also no differences in overall quality of life between the two arms. We will present new data on the detailed quality of life and functional status of patients who have